Understanding Psoriasis

What is psoriasis, and what causes it?

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Psoriasis is a chronic, noncontagious skin disorder that causes patchy scales to develop all over a person's body. It affects approximately 5 percent of Americans and is the result of an abnormality in the immune system. Certain medications, such as beta-blockers, and outside triggers like stress can provoke outbreaks. Various strains of psoriasis exist, but the most common form is called plaque psoriasis. Although symptoms can disappear for short periods, psoriasis is a recurring condition.

What Causes Psoriasis?

When the body's immune system functions properly, its white blood cells produce antibodies that fight off disease and infection and heal the skin. Psoriasis occurs when the immune system creates too many white blood cells, which then pile up on the surface of the skin in the form of inflamed, scaly lesions.

Most experts believe psoriasis is genetic. If both parents are afflicted, there is a 41 percent chance that a child will be, too. (If only one parent has psoriasis, there is a 14 percent chance a child will inherit it.) What's more, certain environmental elements can trigger an outbreak — for example, a sunburn, or friction caused by clothing that rubs against the skin. Stress, which can trigger outbreaks, also plays a role in prolonging them: One British study found that women who worried frequently were two times less likely to respond to treatment than women who were free of stress. Infections with streptococcus (a bacterium that causes tonsillitis, impetigo, and strep throat) provoke flare-ups, especially in children. Certain drugs can also trigger outbreaks: If at all possible, people who are prone to psoriasis should avoid taking ACE inhibitors and beta-blockers (medications used to treat high blood pressure) and lithium (used to treat bipolar disorder).

Symptoms of Psoriasis

Look for raised, crusty red patches (called plaques) with silver-colored scales, which are typically found on the scalp, knees, back, elbows, hands, or feet. The patches usually itch, especially when located in folds of skin (that is, in the armpits, behind the knees, between the buttocks). Joint swelling and yellowish discoloration in the nail beds are also common.

Complications of Psoriasis

Of people with psoriasis, 11 to 40 percent also develop arthritis, typically between the ages of 20 and 50. Called psoriatic arthritis, this condition causes joint stiffness in the morning, as well as inflammation and pain in the fingers and spine. Pink scales also appear on the knees, elbows, lower back, and chest. If the condition is left untreated, it can cause permanent damage to the joints.

Additionally, a recent study in the Journal of the American Academy of Dermatology indicates that people with severe cases of psoriasis are more likely to develop other serious complications, including depression, obesity, cardiovascular disease, hypertension, diabetes, cancer, and immune-related conditions, such as Crohn's disease.

Diagnosing Psoriasis

Although there are no blood tests or other procedures that can diagnose the disorder, the signs are usually easy for doctors to spot just by looking at a patient's skin. A skin biopsy may be performed to confirm the diagnosis.

Treating Psoriasis

Depending on the person's age and the severity of his or her condition, the search for the most effective treatment for psoriasis is usually a trial-and-error procedure. First, a topical treatment like a medicated cream containing coal tar, retinoid, or vitamin D3 is applied directly to the plaques to reduce inflammation, remove scales, and balance the production of skin cells. If that doesn't help, another option is UVB radiation. In this therapy, brief daily exposure to sunlight is used to stop cell production and clear up plaques. A third treatment involves administering medications by pill or biological injections (called systemic treatment). This is an ongoing therapy to prevent recurrence; medicines used include methotrexate and cyclosporine (both are "immunosuppressants," which reduce cell growth and inflammation) and retinoid (a synthetic form of vitamin A).

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